Background
Although several reports have shown that proton beam therapy (PBT) offers promise for patients with skull base cancer, little is known about the frequency of late toxicity in clinical practice when PBT is used for these patients. Here, we conducted a retrospective analysis to clarify the late toxicity profile of PBT in patients with malignancies of the nasal cavity, para-nasal sinuses, or involving the skull base.
Methods
Entry to this retrospective study was restricted to patients with (1) malignant tumors of the nasal cavity, para-nasal sinuses, or involving the skull base; (2) definitive or postoperative PBT (>50 GyE) from January 1999 through December 2008; and (3) more than 1 year of follow-up. Late toxicities were graded according to the common terminology criteria for adverse events v4.0 (CTCAE v4.0).
Results
From January 1999 through December 2008, 90 patients satisfied all criteria. Median observation period was 57.5 months (range, 12.4–162.7 months), median time to onset of grade 2 or greater late toxicity except cataract was 39.2 months (range, 2.7–99.8 months), and 3 patients had toxicities that occurred more than 5 years after PBT. Grade 3 late toxicities occurred in 17 patients (19 %), with 19 events, and grade 4 late toxicities in 6 patients (7 %), with 6 events (encephalomyelitis infection 2, optic nerve disorder 4).
Conclusions
In conclusion, the late toxicity profile of PBT in patients with malignancy involving the nasal cavity, para-nasal sinuses, or skull base malignancy was partly clarified. Because late toxicity can still occur at 5 years after treatment, long-term follow-up is necessary.
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References
Ketcham AS, Wilkins RH, Vanburen JM, Vanburen JM, Smith RR (1963) A combined intracranial facial approach to the paranasal sinuses. Am J Surg 106:698–703
Blanco AI, Chao KS, Ozyigit G et al (2004) Carcinoma of paranasal sinuses: long-term outcomes with radiotherapy. Int J Radiat Oncol Biol Phys 59(1):51–58
Hoppe BS, Stegman LD, Zelefsky MJ et al (2007) Treatment of nasal cavity and paranasal sinus cancer with modern radiotherapy techniques in the postoperative setting: the MSKCC experience. Int J Radiat Oncol Biol Phys 67(3):691–702
Jansen EP, Keus RB, Hilgers FJ, Haas RL, Tan IB, Bartelink H (2000) Does the combination of radiotherapy and debulking surgery favor survival in paranasal sinus carcinoma? Int J Radiat Oncol Biol Phys 48(1):27–35
Dulguerov P, Jacobsen MS, Allal AS, Lehmann W, Calcaterra T (2001) Nasal and paranasal sinus carcinoma: are we making progress? A series of 220 patients and a systematic review. Cancer (Phila) 92(12):3012–3029
Snyers A, Janssens GO, Twickler MB et al (2009) Malignant tumors of the nasal cavity and paranasal sinuses: long-term outcome and morbidity with emphasis on hypothalamic-pituitary deficiency. Int J Radiat Oncol Biol Phys 73(5):1343–1351
Dirix P, Nuyts S, Geussens Y et al (2007) Malignancies of the nasal cavity and paranasal sinuses: long-term outcome with conventional or three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys 69(4):1042–1050
Hoppe BS, Nelson CJ, Gomez DR et al (2008) Unresectable carcinoma of the paranasal sinuses: outcomes and toxicities. Int J Radiat Oncol Biol Phys 72(3):763–769
Nutting CM, Morden JP, Harrington KJ et al (2011) Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial. Lancet Oncol 12(2):127–136
Zenda S, Kohno R, Kawashima M et al (2011) Proton beam therapy for unresectable malignancies of the nasal cavity and paranasal sinuses. Int J Radiat Oncol Biol Phys 81(5):1473–1478
Nishimura H, Ogino T, Kawashima M et al (2007) Proton-beam therapy for olfactory neuroblastoma. Int J Radiat Oncol Biol Phys 68(3):758–762
Fuji H, Nakasu Y, Ishida Y et al (2011) Feasibility of proton beam therapy for chordoma and chondrosarcoma of the skull base. Skull Base 21(3):201–206
Debus J, Wuendrich M, Pirzkall A et al (2001) High efficacy of fractionated stereotactic radiotherapy of large base-of-skull meningiomas: long-term results. J Clin Oncol 19(15):3547–3553
Lee DS, Kim YS, Cheon JS et al (2012) Long-term outcome and toxicity of hypofractionated stereotactic body radiotherapy as a boost treatment for head and neck cancer: the importance of boost volume assessment. Radiat Oncol 7:85
Mizoe JE, Hasegawa A, Jingu K et al (2012) Results of carbon ion radiotherapy for head and neck cancer. Radiother Oncol 103(1):32–37
Stelzer KJ (2000) Acute and long-term complications of therapeutic radiation for skull base tumors. Neurosurg Clin N Am 11(4):597–604
Sheline GE, Wara WM, Smith V (1980) Therapeutic irradiation and brain injury. Int J Radiat Oncol Biol Phys 6(9):1215–1228
Marks JE, Baglan RJ, Prassad SC, Blank WF (1981) Cerebral radionecrosis: incidence and risk in relation to dose, time, fractionation and volume. Int J Radiat Oncol Biol Phys 7(2):243–252
Woo E, Lam K, Yu YL, Lee PW, Huang CY (1987) Cerebral radionecrosis: is surgery necessary? J Neurol Neurosurg Psychiatry 50(11):1407–1414
Hotta K, Kohno R, Takada Y et al (2010) Improved dose-calculation accuracy in proton treatment planning using a simplified Monte Carlo method verified with three-dimensional measurements in an anthropomorphic phantom. Phys Med Biol 55(12):3545–3556
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Zenda, S., Kawashima, M., Arahira, S. et al. Late toxicity of proton beam therapy for patients with the nasal cavity, para-nasal sinuses, or involving the skull base malignancy: importance of long-term follow-up. Int J Clin Oncol 20, 447–454 (2015). https://doi.org/10.1007/s10147-014-0737-8
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DOI: https://doi.org/10.1007/s10147-014-0737-8